Analysis of a Diagnosis of a Behavioral Disorder in a Teenage - Assignment Example

Analysis of a Diagnosis of a Behavioural Disorder in a Teenage Abstract: This report is a diagnosis of a behavioural disorder in a teenage boy who has been described by his teachers as a loner who appears to prefer his own company. This report presents an evaluation of the presenting symptoms and arrives at a diagnosis of generalised social anxiety disorder. This report also assess why this behavioural condition presents a problem, i.e., it impacts upon his behaviour and interferes with his normal social interactions with others at his school. The case of A: The subject of this study is a fifteen year old teenage boy who will be identified for purposes of this Report as A, in order to preserve his anonymity. Based upon his school reports, he has always been a shy boy, tending to prefer his own company to active interaction with his peers at school. He performs well in ICT based work, but where his oral skills and class participation is concerned, A seems reluctant to take an active part. As per his school assessment reports, A stutters and blushes when asked to make oral presentations and appears to be tongue tied most of the time. During P.E. sessions, he appears to prefer solitary physical activities as opposed to playing in teams. He appears anxious and nervous when interacting with his peers and teachers and spends his lunch breaks eating alone or playing on the school computers. A reports that he prefers to be alone most of the time out of the fear that his peers might find him awkward and he is afraid he might embarrass himself when interacting with them. He also reports that his inner anxiety tends to make him self-conscious and irritable whenever he finds himself in situations where he needs to interact with others. He also has difficulty sleeping most nights, because of the tension generated through his thoughts and worry about facing school every day. His family environment only appears to exacerbate his condition, because he is the only child and both his parents also lead fairly solitary lives. A also reports that since the onset of adolescence, he has only found himself even more anxious and self-conscious. Diagnosis of A’s condition: There is no indication that A is abusing drugs, he reports that he does not drink either, so he is not in danger of developing the symptoms of alcoholism. As per the diagnostic criteria laid out in the DSM-IV, it appears that A is suffering from generalised social anxiety disorder, because it is “not due to the direct psychological effects of a substance (e.g.,a drug of abuse, a medication) or a general medical condition (e.g.,hyperthyroidism) and does not occur exclusively during a Mood Disorder, a Psychotic Disorder, or a Pervasive Developmental Disorder”.(DSM-1V, 1994: 435-436). Social anxiety disorder has been described as an anxiety disorder in which a person has “an excessive and unreasonable fear of social situations”, which produces “intense nervousness and self consciousness” that arise from the fear of being closely watched, judged and criticized by others (Heimburg, 1995:3). Schneier (2003) has provided an assessment of the current extent of knowledge about social anxiety disorder, i.e, it is common, it is under diagnosed, it is impairing, but above all, it is treatable. Furthermore, Scheiner et al (1994) have also pointed out that individuals with social anxiety disorders are frequent users of the health care system, and their social phobias can be considerably worsened if they are also associated with other kinds of mental disorders. In the case of A, the disorder is still in its formative stages because of his young age, hence early intervention could be very effective in alleviating the symptoms. Since A is an adolescent, the disorder is proving to be especially traumatic because of the self consciousness and anxiety to please peers that is already associated with this phase in an individual’s life. A is becoming more and more introverted and his chances of success in life are being reduced further as the days pass. Hence, in order to deal with the condition, the following recommendations and treatment is suggested. Recommended treatment: Social phobia is not an easy condition to treat, although it is not overly difficult to describe or recognize it. In carrying out an initial assessment of a patient and arriving at a preliminary formulation, it may be necessary to explore both general and more specific aspects of the problem. In general, there are two approaches that have been applied in the treatment of social anxiety disorder, i.e., the pharmacological approach and the cognitive approach. Butler and Wells (in Heimburg, 1995:310) have argued that the most productive model on the basis of which a clinical application may be made in the case of social anxiety disorder is the cognitive model. The cognitive behavioural therapy approach has been found to be beneficial in treating this condition, especially in treating generalized social anxiety, because this clinical approach focuses on the patient’s thought processes and belief systems (Beck, 1995). As Butler and Wells state, cognitions play a central part in the definition of social phobia as well as in its secondary aspects. Some clinicians tend to apply well established, traditional psychological methods such as exposure, relaxation and anxiety management to deal with the symptoms of nervousness and stress, which in some instances can be very successful. However, applying the cognitive approach would be extremely useful, not only in cases where the patient is resistant to such treatments, but in actually improving outcomes through the application of such methods (Heimburg, 1995:311). In the treatment of social phobia, Butler (1985) recommends the use of exposure, by engaging the patient in thinking rationally about how to interact better with people, while using brief, unguarded opportunities that arise to seek that exposure until there is a gradual increase in such exposure to social situations and contacts with people. In examining the various means for the treatment of severe social phobia, Mattick (1988) reported that the best predictor of a long term favourable prognosis in the case of social phobia was to change the cognitive component of social anxiety, i.e., help patients recognize that their automatic perception of negative evaluation and criticism from others might not necessarily be true. Some of the techniques used in this study to improve treatment outcomes for social anxiety included training by self instruction and application of the cognitive behavioural theory. Every patient’s cognitive perceptions are different and if the therapist is to achieve a successful outcome, it is important that s/he does not automatically classify the patient’s thoughts and fears as irrational. If the therapist approaches the problem with the idea of merely replacing the patient’s existing set of cognitive beliefs with another, this may not achieve a long term change. Rather the effort of the therapist should be to listen to the patient’s internal dialogue and clarify it without giving the impression that is a right and a wrong set of cognitive beliefs (Bower, 2003). The attempt made in applying a cognitive approach is to “modify both the dysfunctional thoughts and beliefs that underlie distress”.(Heimberg, 1995:319). This appears to be the kind of treatment indicated in A’s case, because altering his cognitive perception that he will embarrass himself or that others will criticize him could be effective in dealing with the disorder. References: American Psychiatric Association, 1994. Diagnostic and Statistical Manual of Mental Disorders (4th ed). * Beck, J.S., 1995. “Cognitive therapy: basics and beyond”, Guildford Press. * Butler, Gillian, 2002. “Exposure as a treatment for social phobia: Some instructive difficulties”, Behaviour Research and Therapy, 23(6): 651-657 * Heimburg, Richard G, 1995. “Social phobia: diagnosis, assessment and treatment”, Guildford Press. * Mattick, R.P., 1988. “Treatment of severe social phobia: effects of guided exposure with and without cognitive restructuring”, Journal of Consulting and Clinical Psychology, 56(2):251-60 * Heimburg, Richard G, 1995. “Social phobia: diagnosis, assessment and treatment”, Guildford Press. Read More